The periodontal pocket cleaner is a device for removing foreign material from periodontal pockets and periodontal sulci and from the tooth surfaces adjacent to such pockets and sulci. The periodontal pocket cleaner is particularly useful for removing foreign material from interdental periodontal pockets.
The gingiva of the healthy periodontium is normally attached to the tooth and gives support to the tooth. The margin of the healthy gingival attachment includes a gingival sulcus, i.e. a slight recession of the gingival attachment which results in a small detachable space between the tooth and the surrounding gingiva at the margin. A periodontal pocket occurs if the recession of the gingival attachment extends beyond the normal sulcus beyond approximately 4 mm. in depth.
The etiology of the formation of periodontal pockets is not fully understood. However, pathological sequelae to the formation of a periodontal pocket can be pernicious to the health of the periodontium. The growth and formation of bacterial plaque in the vicinity of the sulcus are a capital etiological factor in the formation of a pocket. After the periodontal pocket begins to form, the pocket will tend to accumulate more debris, including food particles. This accumulation of debris will further promote bacterial growth and bacterial plaque formation, and may lead to bacterial invasion of the gingival tissues and the excretion of bacterial toxins which can inflame the gingival tissues. The accumulation of debris and the subsequent bacterial infection within the periodontal pocket contributes to the pathological sequelae of pocket formation. The bacterial infection within a pocket can lead to the permanent resorption of the alveolar process, to the subsequent loss of support for the tooth, and to the eventual loss of the tooth itself. The bacterial infection within a pocket can also lead to apical migration of the attachment apparatus and the characteristic gum recession of periodontal disease The bacterial infection may deter reattachment of the gingiva to the tooth and may promote further detachment of the gingiva from the tooth surface, thereby progressively increasing the size and depth of the periodontal pocket, enabling the pocket to accumulate more debris, and compounding the risk of further sequelae.
Removing accumulated materials from the periodontal pocket and destroying the bacteria will ameliorate some or all of the pathological sequelae of pocket formation. Unfortunately, the anatomy of the periodontal pocket inherently limits the accessibility to the pocket. After the formation of the pocket, the detached gingiva continues to lie as a sleeve against the tooth. Any device or agent for cleaning a periodontal pocket must enter through the pocket opening and reach into the deepest sections of the pocket. Interdental periodontal pockets have particularly limited accessibility.
An interdental periodontal pocket is a pocket situated interdentally between a papilla and the proximal surface of a tooth. The proximity of the adjacent teeth spatially hinders access to an interdental pocket for cleaning. Popular prior art devices such as the tooth brush, dental floss, and gum massagers are unable to penetrate completely into or to clean deeper interdental pockets because the are not structured to permit this kind of access. The pocket cleaner is particularly efficacious for cleaning interdental periodontal pockets.
Dental floss can not reach the deeper recesses of peridontal pockets. The protocol for the use of dental floss requires that the floss first be stretched taut against a surface of a tooth in a direction approximately parallel to the gum line. The stretched floss is then moved up and down to remove material from the tooth surface. However, the movement of the floss is limited by the gingival attachment to the tooth. The recess of a pocket lies below the upper most gingival attachment and is substantially inaccessible to the cleaning action of floss. The periodontal pocket cleaner is designed to reach the recesses of a pocket which are inaccessible to floss. Flossing sensitive teeth can sometimes cause discomfort. However, scraping plaque from sensitive teeth with a moistened pocket cleaner is unlikely to cause discomfort because the cleaning surface of the pocket cleaner is soft and because the patient can directly control the pressure and course of contact between the device and the tooth.
A tooth brush may be of some utility for cleaning the lingual and labial aspects of periodontal sulci. However, action of the bristles of the tooth brush is crude for the task of cleaning pockets. The bristles may be unable to fully penetrate the deeper recesses of a periodontal pocket and action of the tooth brush as a whole is relatively indiscriminate. For cleaning interdental pockets, the utility of the tooth brush is negligible because of the spatial hindrance of the adjacent teeth.
Gum massagers are too bulky to penetrate the recesses of periodontal sulci and pockets. Gum massagers are designed to stimulate the gum and to clean tooth surfaces above the gum line. The periodontal pocket cleaner shares some structural similarities to gum massagers. However, the crucial difference between the periodontal pocket cleaner and a gum massager lies in the ability of the pocket cleaner to penetrate the recesses of the periodontal sulci and pockets. Compared to gum massagers, the pocket cleaner has a much smaller size and a much narrower shape. While the reduced size and shape of the pocket cleaner reduces its structural strength compared to gum massagers, the pocket cleaner retains sufficient strength to sweep the sulci and pockets The composition, size, and shape of the pocket cleaner are optimized for strength, but are consistant with the requirement that the pocket cleaner have access to the sulci and pockets As a consequence, if the pocket cleaner is used as a gum massager, it is somewhat less durable than the typical gum massager.
One class of prior art device which is useful for cleaning the recesses of periodontal pockets includes dental curettes. Dental curettes are metallic devices designed to be used by dental hygienists or dentists for scraping and sweeping material from periodontal pockets. Curettes are not designed for patient use. Curettes are metallic and therefore cannot absorb material from the pocket, can not deliver antiseptics to the pocket, and are prone to cause tissue damage to the gingiva due to their hardness. The pocket cleaner is distinguished from the curette because the pocket cleaner has a wooden composition; because the pocket cleaner is primarily suitable for patient use rather than clinical use; because removed blood and other pocket materials are absorbed by the pocket cleaner for better observation and for monitoring the state of pocket disease; and because the pocket cleaner can deliver medication to the pocket recess.
Another class of prior art device which is useful for cleaning the recesses of periodontal pockets includes periodontal brushes. A periodontal brush is a bristle brush with bristles attached to a twisted double wire. The assembly of bristles and twisted wire is designed to be inserted into periodontal pockets. The patient cleans his periodontal pockets by brushing out the pocket material. Because of the differences in composition between the periodontal brush and the wooden periodontal pocket cleaner, they have markedly different properties. The soft hardwood of the pocket cleaner is absorbant and pliant so as not to damage the detached, frequently inflamed, gingival tissues surrounding the pocket; the soft hardwood also absorbs liquid materials including blood from the pocket in order to facilitate the observation of periodontal pathologies and to monitor the state of disease and inflamation of the pocket; the soft hardwood can also be used to deliver medication to the pocket recess; the soft hardwood pocket cleaner is a disposable. The bristles of the periodontal brush cause the brush to be less effective for sweeping along the gingival attachment line than the wooden pocket cleaner.
Toothpick devices share some similarities with the periodontal pocket cleaner. Both devices can be wooden and both devices may be used for cleaning tooth surfaces. However, tooth pick devices are adapted for dislodging food which is jammed between two teeth, while the pocket cleaner is adapted for scraping attached bacterial plaque from the root surface and sweeping loose material from pockets and sulci. Because tooth picks require considerable force to dislodge food jammed between two teeth, they require substantial structural strength and durability. Because of this, tooth picks are relatively large and hard and are therefore inappropriate for cleaning sulci and pockets. Because of its specilized function, the periodontal pocket cleaner lacks the size, strength, and durability of the tooth pick.